Provider Demographics
NPI:1265431993
Name:SACKS, RONALD H (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:H
Last Name:SACKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-0159
Mailing Address - Country:US
Mailing Address - Phone:888-432-7442
Mailing Address - Fax:607-433-0869
Practice Address - Street 1:179 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1019
Practice Address - Country:US
Practice Address - Phone:607-337-4149
Practice Address - Fax:607-337-4205
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1952432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01561857Medicaid
NYBB9672Medicare PIN
NY01561857Medicaid